摘要
目的：比较前路钉棒和后路短节段椎弓根螺钉治疗胸腰段脊椎不稳定性爆裂型骨折的临床疗效，寻找治疗胸腰段脊椎不稳定性爆裂型骨折的有效办法。方法：选择于2008年12月～2014年12月在我院治疗的胸腰段脊椎不稳定性爆裂型骨折患者44例，其中采用后路短节段椎弓根螺钉系统治疗的有20例，设为观察组，采用前路钉棒系统治疗的有24例，设为时照组，比较2组患者围手术期参数、后凸角度纠正以及神经功能恢复情况。结果：（1）观察组患者的围手术期指标（包括手术时间、术中失血、术后伤口引流量）明显优于对照组，组间差异具统计学意义（P〈0．05）；（2）术后，2组患者的后凸角均明显改善，与术前相比差异具统计学意义（P〈0．05），末次随访显示，观察组患者后凸角度丢失严重，与术前相比无明显差异（P〉0．05），对照组后凸角度无明显丢失，与同期观察组相比差异具统计学意义（P〈0．05）；（3）术后，2组患者均未出现神经功能损害加重，末次随访显示，对照组的神经功能状态要略好于观察组，但组间差异无统计学意义（P〉0．05）。结论：前路手术治疗胸腰段脊椎不稳定性爆裂型骨折在防止角度丢失、维持矫形力方面好于后路手术，但手术时间长，术中失血量较多，2种术式各有优缺点，临床应根据患者情况合理选择术式。
Objective： To compare anterior - only fixation by using a corpectomy strut graft and a modern screw - rod system with a posterior only construct by using pedicle screws for treatment of unstable fractures in thoracolumbar region. Methods： 44 cases of Unstable Thoracolumbar Burst Fractures hospitalized from December 2008 to December 2014were divided into two groups, a total of 20 patients with thoracolumbar burst fracture underwent posterior short -segment pedicle screws fixation （the observation group）, the other 24 patients received anterior screw rod system （ the control group）, the sagittal plane restoration, maintenance of sagittal plane alignment, perioperative parameters and neurologic function recover were evaluated. Results： （1）Perioperative index（ including the operation time, intraoperative blood loss, postoperative wound drainage） of the observation group was significantly better than that of the control group, with statistically significant difference （P 〈 0.05 ） ;（2）After operation, both groups＇kyphosis were significantly improved, difference was statistically significant compared with the preoperative（ P 〈0.05 ）, according to the last follow - up, the observation group＇s kyphotic angle were seriously lost, without statistically significant compared with the preoperative（ P 〉 0.05 ）, the control group＇s kyphotic angle were maintain good, the difference has statistical significance compared with the same period in the observation group （P 〈 0.05 ） ;（3）After operation, The two groups had no neurologic impairment, according to the last follow - up, neural function of the control group was slightly better than the observation group, but there was no significant difference（ P 〉0.05 ）. Conclusions： The anterior approach is superior to posterior approach in kyphosis restoration and maintenance of sagittal plane alignment, however, which has much more operative time and blood loss, there are pros and cons in both Operation types, clinical surgical method choice should be based on the case.
出处
《中国伤残医学》
2016年第3期1-3,共3页
Chinese Journal of Trauma and Disability Medicine
关键词
胸腰椎
爆裂性骨折
内固定
手术入路
Thoracolumbar
Burst fracture
Internal fixation
Operation approach
